Choquet Anaïs, Sokal Aurélien, Dokmak Safi, Le Bot Audrey, Delahaye Fanny, Dembinski Jeanne, Aussilhou Béatrice, Rebours Vinciane, de Lastours Victoire, Sauvanet Alain
Department of HPB Surgery, AP-HP, Beaujon Hospital, University of Paris-Cité, Clichy, France.
Department of Internal Medecine, AP-HP, Beaujon Hospital, University of Paris-Cité, Clichy, France.
World J Surg. 2025 Sep;49(9):2570-2577. doi: 10.1002/wjs.70037. Epub 2025 Aug 7.
Recurrent nonobstructive cholangitis (RNOC) due to enterobiliary reflux is a late complication of pancreaticoduodenectomy (PD) that should be differentiated from obstructive cholangitis. The risk factors (RFs) of RNOC are poorly known. The goal of this study was to estimate the prevalence, to identify the RF, and to describe the management of RNOC following PD.
This case-control study included 503 patients from a prospective database (2014-2018) who underwent PD; one hundred and eighty-three patients were excluded because they had less than 1-year of follow-up, tumor recurrence during postoperative year one, or cholangitis from anastomotic stenosis or tumor recurrence. RNOC was defined as at least 3 episodes of cholangitis that occurred or persisted more than 1-year after PD, without anastomotic stenosis or tumor recurrence. RF were identified by univariate and multivariate analyses.
Of the 320 analyzed patients, 213 (67%) and 107 (33%) underwent PD for malignancy and a benign lesion, respectively. With a median follow-up of 47 months (IQR: 33-68), 27 of the 320 patients (8%) developed RNOC (median number of episodes = 8 and IQR = 5-12). The only independent RF for RNOC was noninvasive IPMN (OR = 3.222; IC-95% = 1.219-8.514; and p = 0.018). All patients received on-demand antibiotics. Three patients (11%) developed complications from RNOC (hepatic abscesses in 3 and organ failure in one). No patients died from RNOC. Two (7%) patients underwent reoperation to lengthen the biliary Roux-en-Y loop but RNOC persisted in both.
RNOC complicates 8% of PD. Noninvasive IPMN was a RF of RNOC. The value of revision surgery to limit the risk of recurrence seems limited.
因肠胆反流导致的复发性非梗阻性胆管炎（RNOC）是胰十二指肠切除术（PD）的一种晚期并发症，应与梗阻性胆管炎相鉴别。RNOC的危险因素尚不清楚。本研究的目的是评估RNOC的患病率，确定其危险因素，并描述PD术后RNOC的治疗方法。
本病例对照研究纳入了前瞻性数据库（2014 - 2018年）中接受PD手术的503例患者；183例患者因随访时间不足1年、术后第1年出现肿瘤复发或因吻合口狭窄或肿瘤复发导致胆管炎而被排除。RNOC定义为PD术后至少发生3次胆管炎发作或持续超过1年，且无吻合口狭窄或肿瘤复发。通过单因素和多因素分析确定危险因素。
在320例分析患者中，分别有213例（67%）和107例（33%）因恶性肿瘤和良性病变接受了PD手术。中位随访时间为47个月（四分位间距：33 - 68个月），320例患者中有27例（8%）发生了RNOC（发作次数中位数 = 8次，四分位间距 = 5 - 12次）。RNOC唯一的独立危险因素是非侵袭性胰腺导管内乳头状黏液性肿瘤（OR = 3.222；95%置信区间 = 1.219 - 8.514；p = 0.018）。所有患者均接受按需使用抗生素治疗。3例患者（11%）出现了RNOC相关并发症（3例发生肝脓肿，1例发生器官衰竭）。无患者死于RNOC。2例（7%）患者接受了再次手术以延长胆肠Roux - en - Y袢，但2例患者的RNOC仍持续存在。
8%的PD患者会并发RNOC。非侵袭性胰腺导管内乳头状黏液性肿瘤是RNOC的一个危险因素。通过再次手术来降低复发风险的价值似乎有限。
